Fertility in midlife women

Reduced maternal fertility is the consequence of depletion of follicles with maternal aging. In a 35-year-old woman, approximately 9.1% of the residual follicle pool disappears annually without entering into the growing stage, whereas, in a 45-year-old woman, this number triples. After the age of 35 years, the frequency of aneuploidies in oocytes increases sharply. Roughly 50-70% of mature oocytes from a 40-year-old woman have chromosomal abnormalities. The clinical pregnancy and implantation rates are lower in midlife women. Various controlled ovarian stimulation interventions have been suggested for the management of women in advanced age, most of whom are likely to be poor-responder patients. Currently, systematic reviews and meta-analyses suggest that there is insufficient evidence to recommend most of the treatments proposed to improve pregnancy rates in these poor responders. Minimal stimulation or natural cycle in vitro fertilization may be offered, without compromising the already existing pregnancy results

Bilateral ovarian krukenberg tumor at mid-gestation | İkinci trimesterde bilateral ovaryen Krukenberg tumörü

Even though adnexal masses are detected during pregnancy ranging from 1 to 81 to 1 in 2.500 pregnancies, only 3% of these are malignant. A Krukenberg tumor is an ovarian metastasis of a gastric tumor and accounts for 1-2% of all ovarian tumors. A 29-year-old woman, gravida 3, para 2, was referred to our unit at 20 weeks’ gestation because of epigastric pain for the last one week. Her abdominal ultrasound revealed a singleton pregnancy, with fetal measurements compatible with 20 weeks of gestation. A solid mass of 12.8 cm by 12 cm localized posterior to the uterus extending to both adnexial regions was also detected. Under general anesthesia, a midline abdominal incision was made. During abdominal inspection the gravid uterus was the size appropriate for the current gestational week. A 12 cm by 13 cm mass originating from the right ovary was excised. Then, a 17 cm by 18 cm mass originating from the left ovary was excised. The final pathology report confirmed positive washing cytology and a metastastic adenocarcinoma of both ovaries. Three weeks later, the woman had a gastroscopic biopsy and the pathology report was of an adenocarcinoma of the stomach. Unfortunately, the woman was lost to follow-upGebelikte adneksiyal kitleler 1/81 ile 1/2,500 sıklıkta görülse de bunların sadece %3’ü maligndir. Krukenberg tümörü, gastrik tümörün yumurtalıklara metastazıdır ve tüm over kanserlerinin %1-2sini oluşturur. Son bir haftada epigastrik ağrısı olan 29 yaşında 20.gestasyonel haftasında olan gravida 3, parite 2 bir kadın ünitemize refere edildi. Abdominal ultrasonografide 20 gebelik haftası ile uyumlu biyometrik ölçümleri olan bir bebek izlendi. Ayrıca her iki adneksiyal alana doğru uzanan rahimin arkasında yerleşimli 12,8 x 12 cm çapında solid kitle tespit edildi. Genel anestezi altında orta hat kesisi ile batına girildiğinde haftasıyla uyumlu büyüklükte gebe uterus izlendi. Sağ overden kaynaklanan 12 x 13 cm kitle eksize edildi. Sol overden kaynaklanan 17 x 18 cm kitle eksize edildi. Nihai patoloji sonucu pozitif batıniçi yıkama sıvısı ve her iki overe adenokarsinom metastazı olarak geldi. Üç hafta sonra yapılan gastroskopik biyopsinin patoloji sonucu midenin adenokarsinomu olarak geldi. Hastamız takiplere gelmedi

The impact of pregnancy rates of using two different cut-off levels for high serum estradiol levels on the day of the hCG injection: Results from the same cohort of patients with long down-regulated ART cycles | Ayni{dotless} yüt hasta kohortunda hcg günü oluşturulan iki farkli{dotless} serum östradiol eşik deǧerlerinin yüt gebelikleri üzerine etkileri

Objective: To determine, from a single cohort of patients whether on the day of the human chorionic gonadotropin (hCG) injection, two different cut-off levels for high serum estradiol (E2) levels affect pregnancy rates in long-down regulated assisted reproductive technology (ART) cycles. Patients and Methods: A retrospective cohort analysis was performed in a University affiliated hospital on 539 women undergoing consecutive in vitro fertilization/intacytoplasmic sperm injection (IVF/ICSI) treatment with long-down regulation and recombinant follicular stimulating hormone (FSH) injections. The cut-off level for high E2 concentration was calculated according to a centile analysis of E2 levels on the day of hCG administration. Women in group 1 were divided into subgroup A with E2 levels from the 25th to 75th centiles (1040-2500pg/ml) and subgroup B with E2 levels from the 75th to 100th centiles (>2500pg/ml), respectively. Women in group 2 were divided into subgroup A with E2 levels from the 10th to 90th centile (650-3100pg/ml) and subgroup B with E2 levels from the 90th to 100th centile (>3100pg/ml), respectively. The clinical pregnancy rates and ongoing pregnancy rates were compared. Results: The clinical pregnancy rates and ongoing pregnancy rates were similar in group 1 and group 2. Conclusion: High serum E2 levels on the day of the hCG injection day either set at 75th (2500pg/ml) or 90th percentiles (3100pg/ml) do not compromise pregnancy rates in cycles downregulated with gonadotropin-releasing hormone (GnRH) analogues. Key words: Gonadotropin-releasing analogue, Human chorionic gonadotropin, Pregnancy, long analogue cycle, EstradiolAmaç: Yardımcı üreme teknikleri (YÜT) uygulanan hasta kohortunda insan koriyonik gonadotropin (hCG) günü oluşturulan iki farklı serum östradiol (E2) eşik değerlerinin YÜT gebelikleri üzerine etkilerinin araştırılması. Hastalar ve Yöntem: Üniversiteye bağlı eğitim hastanesinde uzun süreli gonadotropin salgılayıcı hormon baskısından sonra kullanılan rekombinant folikül stimüle edici hormon (FSH) ile YÜT tedavisi alan 539 ardışık kadın retrospektif analize alınmıştır. hCG günü alınan serum E2 seviyesinin yüksek eşik değeri persentil analizine göre yapılmıştır. Grup 1 için serum E2 seviyeleri 25– 75inci persentilde (1040-2500pg/ml)olanlar alt grup A ; serum E2 seviyeleri 75–100üncü persentilde (>2500pg/ml)olanlar alt grup B olarak ayrılmıştır. Grup 2 için serum E2 seviyeleri 10– 90ıncı persentilde olanlar(650-3100pg/ml) alt grup A ve serum E2 seviyeleri 90–100üncü persentilde (>3100pg/ml)olanlar alt grup B olarak ayrılmıştır. Klinik ve devam eden gebelik oranları karşılaştırılmıştır. Bulgular: Hem grup 1’de hem de grup 2’de klinik ve gebelik oranları benzerdir. Sonuç: hCG günü serum E2 seviyelerinin eşik değeri 75inci (2500pg/ml), veya 90ıncı persentil (3100pg/ml) üzerinde olması GnRH analogları ile baskılanmış uzun protokol YÜT sikluslarında gebelik oranlarını olumsuz etkilememektedir. Anahtar kelimeler: Gonadotropin salgılayıcı hormon analogu, İnsan korionik gonadotropin, Gebelik, Uzun analog siklusu, Östradio

Has fertility declined in recent decades?

Purpose of revie